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New bundled-payment program lacks cushion (subscriber content)

By: Caroline Lewis

DATE: January 11, 2018


DataGen was recently featured in an article from Crain’s New York.

Despite skepticism about the Trump administration’s commitment to value-based payments, the bundled-payment program
that the Centers for Medicare and Medicaid Services announced Tuesday is similar to those designed by the previous
administration. Providers that opt in can choose from 32 types of clinical episodes for which they will be paid based on
their ability to control costs and meet quality measures over a 90-day period.

But unlike previous mandatory bundled-payment programs, this one lacks a period of six months to a year during which
providers face no risk of losses.

The move was “disappointing,” said Darcie Hurteau, a director at consulting firm DataGen, a subsidiary of the Healthcare
Association of New York State.

“It takes some time for providers to get their programs up and running and get all their strategies developed and see some
change in practice patterns,” she said.

After providers submit their initial applications for the program, they will be on a tight timeline to decide whether they can
meet the CMS targets and then implement the strategies they come up with to do so, Hurteau added.

Still, she said, she anticipates broad interest from physician groups as well as hospitals. The program will count as an
advanced alternative payment model, for which physicians can earn participation-based incentive payments under

This story is available in the Crain’s Health Pulse January 11, 2018 newsletter (subscription required).